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Malawi: Knowledge to curb the increase in traffic injuries
"Malawi is among the countries with the most road traffic fatalities in the world. Drunk driving is one of the problems, but to what extent we do not know because of the lack of alcohol testing and investigation," says Asbjørg S. Christophersen, senior researcher and project leader at the Norwegian Institute of Public Health.
The experienced researcher emphasises that more knowledge about road traffic injuries will highlight the problem and give the authorities an incentive to develop and implement preventive measures.
In Malawi, traffic injuries crept up to 10th place in the ranking of causes of premature death in 2010, according to a study from the global burden of disease project, ref. figure below.
Collected basic information about traffic accidents
The idea of the project is that increased knowledge about traffic accidents will give attention and incentives to the authorities to start prevention.
The Ministry of Health in Malawi has recommended the project, which follows up on goals in Malawi’s health strategy and their recently approved national alcohol policy. In addition, the project follows up on the UN Sustainable Development Goal number three, which states that the number of global deaths and injuries from road traffic accidents shall be halved by 2020 – a goal that has not been reached and therefore is suggested postponed till 2030.
The project received grants from the World Bank in 2017, and the planning and preparation has taken a long time. Only at the end of May 2019 could they start recruiting patients.
Traffic-injured patients (18 years or older) were informed of the project as they arrived at the emergency ward at Kamuzu Central Hospital, project partner and the largest public hospital in Malawi. After being informed in English or the local language Chichewa, patients were then asked if they would like to participate in the project.
Two young doctors at the emergency unit at Kamuzu measured the alcohol levels in the patients and registered this information in a form on iPad, developed for the project, in cooperation with the Norwegian project group and the group at Kamuzu.
Depersonalised dataThe data were depersonalised before registered in the iPad programme.Experts from the Norwegian Institute of Public Health and Oslo University Hospital are supervisors (see text box).
High participation rateIn about three months, 1347 traffic-injured patients were asked to participate in the project. Of these, 88 refused to participate, which mean that the result was a participation rate of 93.5. Of those, 19.2 percent were women.– The high percentage of participants is particularly gratifying since the project was predicted low interest before we started the collection, as it was alcohol we should measure, says Asbjørg S. Christophersen.
Passengers is the largest patient groupThe largest patient group was passengers (36%), followed by pedestrians (17.6%), cyclists (14.6%), motor vehicle drivers (14.5%), motorcyclists (12%), and a smaller group where the type of road user did not stay registered (about 5%).
Men and pedestrians more often influenced by alcoholAlcohol was detected in 25.9% of men and only 2.5% of women. Alcohol was most common in the age group 26–34 years (25.6%) and in pedestrians (41.8%), followed by motorcyclists (24%), car drivers (23.8%), bus / minibus / lorry drivers (20, 8%), passengers (19.8%) and cyclists (19.1%).
Higher alcohol levels at weekend nightsMost dangerous and highest alcoholic occurence was detected at weekend nights (00.00 - 06.00) in 58.3%, and 36.8% in the afternoon / evenings (18.00 - 24.00). In the afternoon / evening on regular weekdays (18.00 - 24.00), alcohol was detected in 34.4%.
Publishing of dataThree articles are submitted for publication in various international journals. Two more articles are being planned.
Received the Robert Borkenstein PrizeThe Norwegian Public Health Institute received the Robert Borkenstein Prize awarded to Asbjørg S. Christophersen at the ICADTS (International Council on Alcohol and Drugs and Traffic Safety) conference in Edmonton, Canada, in 2019, for the implementation of the project. The prize is only awarded every three years.
The corona pandemic has put the follow-up on holdA seminar in Lilongwe scheduled for early fall 2020 has been cancelled due to the Covid-19 pandemic. In collaboration with the local World Bank branch, the project was to present results to representatives from ministries (health, transport, justice), the police, the embassy, the media and organisations working with traffic safety and prevention of alcohol and other substance abuse. Employees at Kamuzu should also get involved.Video seminars have been discussed, but for the time being, there are often major technical problems with this type of seminar in a country like Malawi.Since the World Bank has a deadline at the end of November 2020, the project has applied for postponement so that the seminar can be arranged with participants from the project group in Norway, for example around the summer of 2021. This will of course only happen if the Covid-19 situation allows it.
A prerequisite for knowledge-based policy
The results will provide the governmental authorities in health, transportation and justice with particularly valuable information to shape a knowledge-based policy to improve road safety and create effective information campaigns. Christophersen refers to a poll that found that the 0.8-alcohol legal limit in Malawi for driving a motor vehicle is little known to people.
− A reduction in traffic accidents could save Malawi health care resources, save lives and tragedies because individuals become disabled and destroyed for the rest of their lives.
This is the first time that the Norwegian Institute of Public Health has received project funding from the World Bank. The international organisation ICADTS (International Council on Alcohol Drugs and Traffic Safety) and the Norwegian Council for Road Safety have also contributed. The Church Aid’s local office in Lilongwe has been responsible for disbursements in Malawi.
Chifundo Kajombo – project coordinator, KCH
Christophersen AS, Mørland J, Stewart K, Gjerde H. 2016. International Trends in alcohol and drug use among motor vehicle drivers. Forensic Sci Rev. 28(1):38–66.
World Health Organization. 2018a. Global status report on alcohol and health 2018. Geneva, Switzerland: World Health Organization.
Dräger Alcotest 5820, Drägerwerk AG & Co., Lübeck, Germany.
Q.E.D.® A150, Orasure Technologies, Inc., Bethlehem, PA, USA.
Eide AH,,Braathen S, Azalde G, Munthali A, Chiocha M, Ndawala J, Natvig H, Hoel E. Fighting poverty alcohol misuse prevention in Malawi – revised summary report (December 2013) SINTEF Technology and Society, 2013–12 -16.
Traffic injuries in the world
Nearly 1.3 million people die each year in road traffic accidents
20–50 million people are injured in traffic accidents each year
90 per cent of accidents occur in low and middle-income countries even though they only have 50% of the car fleet
Road traffic accidents are among the three leading causes of death between the ages of 5 and 44 years
- Unless effective safety measures are introduced soon, road traffic accidents will become the fifth largest cause of deaths globally and the number of deaths will increase to 2.4 million per year
Source: World Health Organization